Application No.
DR. B. R. AMBEDKAR OPEN UNIVERSITY Road No. 46, Prof. G. Ram Reddy Marg, Jubilee Hills, Hyderabad – 500 033
Application for Admission into Master of Philosophy (M.Phil.)/Doctor of Philosophy (Ph.D.) Programme
1. PROGRAMME
i) M.Phil./Ph.D.
ii) Subject
2. NAME: First Name Middle Name Surname
3. FATHER’S/ MOTHER’S NAME 4.
DATE OF BIRTH DD
5. GENDER:
6. SOCIAL CATEGORY [Please tick [√] 7.
MM
YYYY
Male
OC
Female
BC-A BC-B BC-C BC-D BC-E
SC
ST
Any other category (example: PH)
8. Are you employed?
Yes
No
If employed, mention
Designation: ..……………….………………………………….……………..………………
Name & Address of the Organization: .…………………………………………..…………. ………………………………………..……………. ………….………………………………………..… ………….………………………………………..…
9. EDUCATIONAL QUALIFICATIONS (Tick the relevant box(s) and write the subject in the blank space) 8.1
Qualified at the UGC-CSIR/JRF/NET/SLET/GATE exam in the subject _____________
8.2
M .Phil. in the subject of ____________________________________________________
8.3
Post-graduation with 55% marks and above in the subject of _______________________
8.4
Post-graduation with 50% marks and above in the subject of _______________________
8.5
Any other (specify the programme & subject) __________________________________
Total Marks in Post-graduation
Marks Secured
Percentage of Marks *
For the calculation of percentage of marks, marks of all the subjects/papers of the postgraduate programme mentioned will be taken into consideration irrespective of the respective university’s method of calculating the percentage.
10. Proposed Topic for the Ph.D. programme: (Enclose a research proposal) ..………………………………………………..………….……….……………………………….…… .………………………………………………………………………………………..………………… 11. Articles published, if any: (enclose published articles) …………………………………………………………….……….……………………………….…… .………………………………………………………………………………………..………………… 12. Mention the Registration fee particulars: DD. No…………..….. Date………..…… Amount ………………….……...………………….…… Bank…………………………………….… Branch ………………………… Place……..……..……. (Please pay the required fee in the form of Demand Draft from a nationalized bank drawn in favour of “The Registrar, Dr. B. R. Ambedkar Open University, payable at Hyderabad”). 13. Affix Passport-size Photograph and signature in the space given below:
Paste Your Latest Passport Size Photograph
Signature of the Applicant
14. ADDRESS FOR CORRESPONDENCE / PERMANENT Name: ………………………………………………………….………………………...…………… Full Address: …………………………….……………………………………………..…..………… ….…………….……………..…………………………………………………….……..……………. …………………………………………… Pin Code Phone (with STD code) : ……………………………………………………………………. E-mail ID
: …………………………………………………………………….
Mobile No.
: …………………………………………………………………….
15. DECLARATION BY THE APPLICANT I hereby declare that all the particulars furnished above are true and correct to the best of my knowledge. I am aware that if any particulars furnished by me are found to be false or incorrect on scrutiny or at any stage, my application may be liable for rejection. Even my admission granted based on such incorrect information may be cancelled. Applicant’s Signature :
Date :
N.B.: The filled in Application along with the supporting documents such as Degree Certificate, Memo of Marks, Experience Certificate, Publications, Research Proposal etc. should reach “The Director (Academic), Dr. B. R. Ambedkar Open University, Road No. 46, Jubilee Hills, Hyderabad-500033” on or before 18.06.2018. Check List of enclosures. Tick ( √ ) the relevant box(s) against your enclosures Certificate(s) of Qualifying Examination Memorandum of Marks of Post-graduation UG
Examination UGC/CSIR/JRF/NET/SLET/GATE/M.Phil. Certificate (if qualified) Give the list of other enclosures (if any) Examination
1.
…………………………………………………..
2.
…………………………………………………..
3.
……………………………………………….….
Research Proposal (only for Ph.D.) Photo copies of Articles published Demand Draft One spare Passport size Photograph